Care Manager, BH - Remote PA (Behavioral Health)

Location: Remote in Pennsylvania; a current Pennsylvania license is required

Salary: $64,285–$102,855 per year

Company

hirify.global provides behavioral health and healthcare management services.

What you will do

• Authorize and review the medical necessity and effectiveness of inpatient and outpatient mental health and substance abuse services.
• Conduct concurrent clinical reviews, telephone triage, crisis intervention, and emergency authorizations within the scope of practice.
• Coordinate discharge planning with providers and facilities and oversee implementation of treatment plans.
• Educate members and providers about behavioral health benefits, community resources, managed care programs, and applicable criteria.
• Analyze utilization data, participate in quality improvement activities, and propose alternative treatment plans when services do not meet medical necessity criteria.
• Collaborate with Physician Advisors, community agencies, and providers while advocating for members' treatment needs.

Requirements

• Current Pennsylvania license meeting state, Commonwealth, or customer-specific requirements.
• One or more required credentials with the necessary degree: CEAP, LMSW, LCSW, LMFT, LPC, LSW, or RN with state or compact-state licensure.
• At least two years of post-degree experience in healthcare, behavioral health, psychiatric, or substance abuse care.
• Experience with inpatient and/or outpatient settings, utilization management procedures, community resources, and providers.
• Knowledge of DSM-5 or the current diagnostic edition.
• Strong organization, time management, communication, analytical, and problem-solving skills.

Culture & Benefits

• Remote work arrangement for candidates licensed in Pennsylvania.
• Potential eligibility for short-term incentives.
• Comprehensive health, life, voluntary, and other benefits.
• Tobacco-free workplace and equal employment opportunity environment.
• Compliance with role-specific security controls and applicable legal, regulatory, contractual, and internal requirements.